Open Access

Case report
Alleviation and prevention of severe allergic rhinitis and
conjunctivitis following long-term lemon juice use: a case report
Konstantinos GI Vazouras*, Jota Partheniou and Ioannis DK Dimoliatis

Address: Department of Hygiene & Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
Email: KGIV* - paquasti@yahoo.com; JP - jotapartheniou@gmail.com; IDKD - idimoliatis@gmail.com
* Corresponding author

Received: 29 October 2008 Accepted: 11 August 2009 Published: 24 August 2009

Cases Journal 2009, 2:8971 doi: 10.4076/1757-1626-2-8971
This article is available from: http://casesjournal.com/casesjournal/article/view/8971
© 2009 Vazouras et al.; licensee Cases Network Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Allergic rhinitis (often coexisting with allergic conjunctivitis) is a highly prevalent, chronic,
inflammatory disease. Most cases are not extraordinary; however, they may result in significant
impairment in quality of life of patients, as well as in economical damage for both health-care system
and patients. This case report describes the experiences of a middle-aged woman with the illness,
who managed to completely alleviate and prevent her symptoms, in terms of intensity and chronicity,
by drinking natural lemon juice diluted with water. Lemon changed her life radically.

Introduction health care practitioners and researchers to more fully

Allergic rhinitis (AR) is a highly prevalent, allergen-
induced, upper-airway inflammatory disease, character-
ized by hyperreactive airway mucosa and episodes of
symptom chronicity with periods of acute exacerbation
[1]. If AR is combined with conjunctivitis, the condition
is termed allergic rhinoconjunctivitis (ARC). AR may be
perennial, which means that patients have symptoms year
round to allergens that have no seasonal variation.
The prevalence of AR is a controversial issue, as published
prevalence rates differ significantly [2]. However, there is
epidemiological evidence that the prevalence of AR is
rising worldwide [3]. This may derive from the recent
increase in airborne pollution, in dust mite populations,
as well as other agents, or even from the “hygiene
hypothesis” [1,4].
Most cases of allergic rhinitis are not extraordinary, yet the
patients’ experiences provide a unique opportunity for
understand its impact on patients’ health. Significantly, AR
has been described as a disease that may appear quite
bearable to the nonsufferer [5]. This alternative case report
presents a fairly typical case of an adult (the second
author) with ARC. However, rather than presenting
laboratory, or other, findings, we use her interview to
highlight her experiences and journey with allergic
rhinoconjunctivitis, as well as her totally unexpected
therapy and prevention using lemon.
Case presentation
The patient is a 63-years-old, single, Greek female who
weighs 60 kilograms (weighed 48 kilograms in 1981) and
is 1.50 meters tall. She is consultant of preschool
education and distinguished poet. She characterizes her
current health condition as “excellent”. According to her
medical case history, she had generalized ARC from 1981
(period of first diagnosis) to 1984, whereupon she was
almost cured. Other health issues include primary

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infection by Mycobacterium Tuberculosis, without mani-
festing symptoms of tuberculosis, just after the appearance
of ARC (1981), detection of helicobacter pylori, gastro-
esophageal reflux (2003), chronic gastritis (2003),
hypercholesterolemia (2003). She also underwent laparo-
scopic cholecystectomy (2003) after the diagnosis of acute
cholocystitis. Her current medication comprises ezeti-
mibe/simvastatin (2005) and esomeprazole magnesium
(2006). She has a family history of cancer (brother, cousin,
uncle) and gastro-esophageal reflux (father), but no family
history of allergies. She reported neither drug nor alcohol
abuse. She had been smoking 3-6 cigarettes daily from
1966 to 1996 and has been drinking 1-2 cups of coffee
daily. She exercises (walking, dancing) five times a week
for an hour each time.
She first developed ARC in 1981 while working in the
village Katsikas near the city of Ioannina. She reports that
she developed, and still has, hypersensitivity mainly to
washing powder, as well as to most kinds of detergents
(chlorine water, ammonia-containing solutions), every
kind of dust, house dust mite and dust produced by road-
traffic, gas fumes, air conditioning, pollen, scents of
flowers, blossoms and plants, perfumes and synthetic
aromatics. She cannot remember the exact stimuli or date
of the first allergy symptoms. Describing her case, she
emphasizes that her symptoms appeared all year round,
not in a certain season, everywhere she was, even when she
travelled somewhere or during a journey. ARC occurred
after her exposure to the afore-mentioned allergens and
had no connection with periods of stress or emotional
discomfort. It popped up and went away, popped up, went
away! “I was impressed! But, it followed me even in Russia!
It was not present only in Greece. I thought that something
was wrong with Greek environment!” The symptoms
continued for days, weeks, or even several months and
did not subside even if the allergen had retreated. She had
intense watery rhinorrhea, tearing and irritation of the
eyes, as well as repetitive sneezing. She also had pain,
erythema and unbearable pruritus of the nose, pharynx and
eyes. “Acute crises! Crises! Recurrent crises!” It was terrible!
She mentioned no cough, headache, impaired smell, or
nasal congestion. She said she performed allergy testing
(1982) which revealed the probable allergen she was
reacting to: white poplar of Belarus. “And I said that we
don’t have such kind of poplar here!”
She was treated with corticosteroid pills (She cannot
remember the exact name of the drug) and nasal
decongestant sprays. In periods of acute exacerbation,
she took the corticosteroid pills permanently. This
medication pattern continued for three years. Although it
was really effective in considerably reducing the allergy
symptoms, the patient mentions that the action of
cortisone begun only after three hours. Moreover, she
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noticed that she started to gain weight at the abdominal
regions. This resulted in her low compliance to cortisone-
including medication. “I suddenly started to gain weight.
The pills contained cortisone and my doctor hadn’t
informed me so.”
Though, it is highly important to evaluate the impact of
her illness on her life. For her it was a painful experience,
which impaired her total well-being. She had to confront
recurrent crises and she often was not able to sleep at
night. The symptoms were intense and she had severe
physical discomfort. She was unable to work, to talk with
friends, to have social life when her condition was
aggravated. “I couldn’t go for a coffee and talk with friends.”
Her productivity and concentration were severely restricted.
“I could think of nothing else.”
The solution to her problem came really unexpectedly for
her. It was a period of crisis in 1984, when she also had
nausea and a feeling of stomach discomfort. Thus, she
tried to drink lemon juice, hoping it would improve her
abdominal pain (popular traditional therapy in Greece).
Oddly enough, She noticed that her coexisting allergy
symptoms improved radically! She tried it again and again
and again; and in all times the result was the same. From
that moment, lemon became an integral part of her life.
Every time she felt that her allergy symptoms come up, she
expressed juice from half or a whole lemon (half if her
symptoms were relatively mild, a whole one when she was
in crisis) and, then, she diluted it with a little water. Lemon
brought a total change to her illness and life. Her
symptoms’ intensity and incidence decreased significantly.
Lemon worked in only half an hour and directly relieved
her crisis. She comments that only lemon juice had this
outcome. She had been drinking orange juice in rich
quantities but it never alleviated the vigour of her
symptoms. The consumption of lemon juice reduced her
rhinorrhea, which started to give its place to a mild nasal
congestion. It also reduced tearing of the eyes, sneezing,
pain and pruritus. The fact is that she no longer had, nor
has, crises.
Discussion
Allergic rhinitis is a major chronic respiratory disease of
high prevalence. The prevalence of self-reported AR is
estimated to 18.7% across Europe [6], and 14.2% across
the United States [7]. In addition, it can be a debilitating
condition which, if untreated, can result in considerable
health-related and economic consequences. It causes a
significant impairment in quality of life of patients,
particularly in general health, vitality, bodily pain, social
functioning, role emotional and mental health, especially
in women [8], along with high direct, indirect, hidden and
out-of-pocket costs for patients and health-care system [1].
Cost and damage to the health of patient may increase in
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Cases Journal 2009, 2:8971
cases of poorly controlled allergic rhinitis. These may lead
to or co-exist with other nasal or sinus diseases, such as
asthma, conjunctivitis, rhinosinusitis, nasal polyps, ade-
noid hypertrophy, tubal dysfunction, otitis media with
effusion, chronic cough, laryngitis, gastro-esophageal
reflux [2].
According to studies, such as “Allergic rhinitis management
pocket reference 2008” and “ARIA 2008” [2,9], we could
classify her case as severe allergic rhinoconjunctivitis, with
periods of remission of her symptoms. She showed very low
compliance to cortisone therapy and this is reasonable
because the more a certain type of medication inhibits
the performance of daily activities, negatively affects the
physical functioning and identity issues of the patient, the
less is the patient willing to carry it out successfully [10].
Lemon came to her life as a miracle, to change her illness’
routine. No drug can alleviate her symptoms except for
lemon, which is not a drug but a citrus fruit. Thus, there is a
clear causal association between lemon juice and her illness’
therapy [11]. “It’s something utterly necessary in my life.”
Former studies [Medline was searched using the algorithm
(rhinitis OR conjunctivitis OR asthma) allergic lemon on
27 March 2009] have supported citrus fruits’ potential
inhibitory effect on the pathophysiological mechanisms
of IgE-mediated allergic disorders. Kobayashi & Tanabe
provide some evidence that Citrus unshiu powder inhibits
histamine release from basophils of patients suffering
from seasonal allergic rhinitis to cedar pollen: among the
flavonoids in Citrus unshiu powder, hesperetin and
nobiletin inhibited the degranulation of RBL-2H3 cells
via, at least in part, suppression of PI-3 kinase activity [12].
Another possible biological mechanism suggests that
Citrus/Cydonia compilation is likely to induce more
regulatory T-cells, whether CD4+CD25+Fosp3+ natural
or antigen induced IL-10 and/or TGF-b producing Tr-cells,
that are, therefore, very immunosuppressive, and which
are capable of reducing allergen specifically activated Th2
cells [13].
Patient’s perspective
Early days The periods of exacerbation were not for a
while but lasted long, even months! I had awful itching of
my face, particularly of the nose. It was so acute that I
almost poked my fingers at my nose. It was terrible! My
eyelids were fluttering and I had always that sneezing, not
once, but repeatedly, in gusts. It was awful! My nose was
aching and was red, I couldn’t talk. Crises! Crises!
Recurrent crises!
And it was my work that I had to be with kids. It was very
difficult! When I was about to organize a seminar, I had to
undergo therapy in order to prevent a possible crisis. Thus,
I took pills permanently Oh! I didn’t want to take pills at
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all, I didn’t take even an aspirin and the fact that I had to,
ruined my psychological well-being. I couldn’t bear it. I
thought I was too young to take pills.
When I was sick, I couldn’t sleep. On the other hand, my
people really suffered with me. They often said what is that
girl going through, what are we going to do. There were
nights I was in great crisis. It was very painful. I went crazy!
I felt like I was dying.
It was impossible to go out. My problem was predominant
in my life. I always wiped with endless napkins! You
couldn’t live like that, it was isolation! I didn’t want to see
anybody, nor for anybody to see me. I just wanted to
disappear!”
Later days “When I was working in Messolongi (a town
248 kilometres from Athens) in 1984, I had a problem
with my stomach; I had nausea. So, I tried lemon and this
did me good. I felt that my stomach improved and, at the
same time, my allergy started fading! I expressed juice
from a lemon.
If my symptoms were intense, I drank juice from one
lemon. If they were mild, juice from half a lemon. My
crises are now reduced very much! They’re not as frequent
(they may come up 2-5 times a year) and intense as they
used to.
I always carried lemons with me, at all my journeys, even
on vacation! I may have forgotten my toothbrush, or
anything else, but no way the lemons! I always carried, and
still carry, a knife and a lemon! It’s something utterly
necessary in my life. It’s something I never want to miss. It
will always be in my apartment. I know that I can weather
any crisis with a lemon! With a lemon or a great love story!
For me, lemon blossoms are not only a wedding symbol,
but also a broad symbol of Greek culture. As a little kid,
in my village, I saw how people used them to make the
wedding wreath and the brides wearing them. Yet, I love
the leafage, this magnificent dark-green leafage, which is
smooth and shiny and its perfect scent! I believe that
lemon, among all citrus fruits, and the lemon blossoms of
course, is something beloved to me! And to poetry as well!
Lemon completely solved my problem! I have been living
25 years without this illness! I’m too happy.
Abbreviations
AR, allergic rhinitis; ARC, allergic rhinitis and allergic
conjunctivitis.
Consent
Written informed consent was obtained from the patient
for publication of this case report. A copy of the written
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consent is available for review by the Editor-in-Chief of

this journal.

Competing interests
The authors declare that they have no competing interests.

Authors’ contributions
KV transcribed the interview into an office document,
analyzed and interpreted the interview material, per-
formed the literature review and wrote the manuscript.
ID suggested the presentation of this case, arranged and
participated to the first meeting of the three authors,
supervised the structure and content of the report, making
substantial corrections to all drafts. JP cooperated exem-
plarily with the other authors during the preparation of the
report and also offered the patient’s perspective. All
authors read and approved the final manuscript.

Acknowledgements
Our thanks to Anastasia Gotovou for her contribution to
the final editing of the text.

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